Comparative Effectiveness of Non-Pharmacological Interventions for Management of Post-Orthodontic Pain: A Systematic Review and Network Meta-Analysis.
Xu Zhang, Mingmin Zhu, Xinyue Li et al.
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In 30 seconds
This systematic review and Bayesian network meta-analysis compared nine non-pharmacological approaches for orthodontic pain after fixed-appliance activation. It included 20 randomised controlled trials with 1,074 participants and assessed pain at six time points from 2 to 72 hours. Effects varied over time: all interventions reduced pain versus control at 2 hours, while none was significant at 12 hours. Acupressure and music therapy ranked among the leading options at most time points; cognitive behavioural therapy ranked first at 24 hours. At 72 hours, music therapy remained significant (MD = 12.2, 95% CrI [0.57, 25.59]).
Key findings
- At 2 hours, all interventions significantly reduced pain versus control; acupressure and music therapy ranked highest (SUCRA 93.1% and 90.1%).
- At 6 hours, acupressure, music therapy, and TENS were significant; TEAS and VBM were not.
- No intervention showed a significant effect at 12 hours; at 24 hours, music therapy and CBT were significant, with CBT ranking first (SUCRA 91.3%).
- At 72 hours, music therapy remained significant (MD = 12.2, 95% CrI [0.57, 25.59]).
Why it matters
Pain after orthodontic activation can impair quality of life, and this analysis suggests that the apparent benefit of non-drug approaches depends on when pain is assessed. The time-specific results may help frame discussions of supportive options, while the variation in findings cautions against assuming that one intervention provides consistent relief throughout the first three days.
What to keep in mind
The authors note inter-study heterogeneity and sparse evidence at some time points, and call for confirmation in large-scale, rigorous RCTs.